HomeMy WebLinkAboutMortgage_Hasselbtink >a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�-eb_R ° FOR DEDUCTION FROM ASSESSED VALUATION
'toil State Form 43709(R12/6-14)
\ - Prescribed by Department of Local Government Finance
INSTRUCTIONS: f' I id ! , io
To be filed in person or by mail. • F. i ed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be bled or postmarked with the County Auditor or County Recorder of the county where the prr(p'I. rf 21 County Auditor
located on or before January 5 of the immediately succeeding calendar year. I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deducti• 's soug; am.--See reverse side for additional instructions and qualifications. .' gr1Aj j;
Applicant wner or contract buyer-see restrictions on reverse side) tv GILIJON COUNTY AUDITOR
Taxing Key number I legal description Record number Page number
2-(iu07v a6 - /9 -D3 - goo - o01.- 36o- o1, s ',a /3 ( 3801-
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
43 Yd ' ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) - QQ �
Name of assignee or other owner or holder of mortgage c1 �T i rd l_.0_42,
45J) I So.co
Drawer Addr ss of assignee(number and street,city,state,and ZIP code) 1 .-...,SJ(�I3
Addr Al 3 3 to / / 6 A
Does applicant own property in any If yes,what county? What Taxing District? Card t 43gc 'suction
other county �. ....................
in Indiana? ❑Yes ❑No ,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indeoreunc.,o,....._. re county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor t County Date(month,day,year)
r
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
\ Signature(owner's lull lname)
� A / Date(month,day,year)
/_/Nt address 46ki. I�i.er MFG
run,:esident address of applicant(number and street,city,state,and ZIP code) { n i
`' c2 7 9 E 7 —o S• V-/LVYU_CGC�� l , 7 !
Person uthorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
•
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.